Suffering has been described as a psychological or spiritual state that can diminish an individual’s capacity to find solace or peace in their present situation. [1] According to Cassell 'suffering occurs when an impending destruction of the person is perceived; it continues until the threat of disintegration has passed or until the integrity of the person can be restored in some other manner.' He observed that modern medicine in its practice can unwittingly contribute at times to patient suffering. [2] He later emphasised that to appreciate the suffering of others requires a full understanding of the personal narrative of the individual. [3] Suffering can engender a 'crisis of meaning' [4] or a spiritual re-evaluation of life’s ultimate importance. Although suffering is widely experienced by palliative care patients, it is often concealed by the individual and not recognised by others.

  • Suffering may occur in the palliative context at any time
  • Suffering is not confined to physical symptoms
  • Suffering is held as a state of severe distress that is subjective and unique to the individual
  • People suffer not only from an illness but also from its treatments
  • One can never anticipate the source of another person’s suffering
  • Healthcare professionals sometimes withdraw from those who suffer because they are unsure how to proceed, or they fear making matters worse
  • Clinicians need to sensitively explore with each patient, in an atmosphere of trust, perceived aspects of their suffering. [3]

Important contributing factors include:

  • Sense of dread of the unknown
  • Loss of equilibrium and being overwhelmed by life’s circumstances
  • Family distress or dysfunction
  • Spiritual or existential concerns
  • Co-morbid depression and / or severe anxiety.

Key messages

  • Suffering is a multidimensional experience related most strongly to physical symptoms, but with contributions from psychological distress, existential concerns, and social-relational worries.

Active research areas

  • The strength of the patient doctor relationship has been emphasised in writings on the nature of suffering. [1-2]
  • Research into the nature of suffering is gaining momentum. [4] It continues to be conceptually explored. [5-6] The research however is still not population specific so that our understanding of the nature of suffering at particular phases of the life cycle is still poor.

PubMed Searches

  1. Williams BR. Dying young, dying poor: a sociological examination of existential suffering among low-socioeconomic status patients. J Palliat Med. 2004 Feb;7(1):27-37.
  2. Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982 Mar 18;306(11):639-45.
  3. Cassell EJ. The nature of suffering and the goals of medicine. Oxford: Oxford University Press; 1991.
  4. Lethborg C, Aranda S, Cox S, Kissane D. To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliat Support Care. 2007 Dec;5(4):377-88.
  5. Chochinov HM. Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer J Clin. 2006 Mar-Apr;56(2):84-103; quiz 104-5.
  6. Breitbart W. Upright and whole: an approach to suffering in the face of death. Palliat Support Care. 2007 Dec;5(4):347-9.
Last updated 18 January 2017